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NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

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Pre Brief

Two days ago, Tina experienced an asthma episode. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had ten episodes of wheezing and has shortness of breath approximately every four hours. Tina presents with continued shortness of breath and wheezing. Be sure to ask pertinent questions during the interview about related body systems Week 2 Shadow Health Respiratory Physical Assessment. This case study will provide the opportunity to carefully assess lung sounds during the physical examination. Be sure to appropriately document your findings using correct medical terminology.

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Reason for visit: Patient presents complaining of a recent asthma episode that is not fully resolved.

Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation / Electronic Health Record
Student Pre-Survey
Lifespan Activity
Review Questions
Self-Reflection Activity

Pre Brief

NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Tina had an asthma episode 2 days ago. At that time she used her albuterol inhaler and her symptoms decreased although they did not completely resolve. Since that incident she notes that she has had ten episodes of wheezing and has shortness of breath approximately every four hours. Tina presents with continued shortness of breath and wheezing. Be sure to ask pertinent questions during the interview about related body systems. NR 509 Week 2 Shadow Health Respiratory Physical Assessment. This case study will provide the opportunity to carefully assess lung sounds during the physical examination. Be sure to appropriately document your findings using correct medical terminology.

Reason for visit: Patient presents complaining of a recent asthma episode that is not fully resolved.

Overview
Transcript
Subjective Data Collection
Objective Data Collection
Education & Empathy
Documentation / Electronic Health Record
Student Pre-Survey
Lifespan Activity
Review Questions
Self-Reflection Activity

NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Subjective Data Collection: 21 of 21 (100.0%) – NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Hover To Reveal…

Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.

  • Found:

Indicates an item that you found.

  • Available:

Indicates an item that is available to be found.

Category

Scored Items

 

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

Finding:

Established chief complaint

Finding:

Reports increased breathing problems and shortness of breath

(Found)

Pro Tip: Foundational questions about general well-being are important in assessing how a patient feels at the current moment. This creates a space for Tina to contextualize her current feeling in relation to a chief complaint.

Example Question:

What brings you in today?

Finding:

Reports decreased effectiveness of inhaler

(Found)

Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.

Example Question:

Why did you decide to seek treatment?

History of Presenting Illness

Finding:

Asked about onset of symptoms

Finding:

Reports symptoms began two days ago

(Found)

Pro Tip: Determining the onset of a health problem is the first step to understanding if the underlying condition is acute or chronic.

Example Question:

How long have you had breathing problems?

Finding:

Asked about frequency and duration of SOB episodes

Finding:

Reports exacerbations lasting several minutes

(Available)

Pro Tip: Knowing the duration of an asthma or shortness of breath episode will give you insight into how effective the patient’s interventions are, and how severe the episode is.

Example Question:

How long do your asthma episodes last?

Finding:

Reports exacerbated breathing about every 4 hours since original episode

(Found)

Pro Tip: The frequency of asthma episodes or shortness of breath might vary over time. Asking Tina about her recent experience will expound upon her current condition.

Example Question:

How many times have you had breathing problems in the past two days?

Finding:

Reports waking up twice a night with asthma the past 2 nights

(Available)

Pro Tip: Many patients with asthma report trouble sleeping. Asking Tina if she has trouble sleeping can indicate the severity of her asthma.

Example Question:

How many times in the past two nights did asthma wake you up?

Finding:

Asked about severity of symptoms

Finding:

Describes asthma severity as “not full attack,” but worse than usual

(Available)

Pro Tip: Asthma severity might change over time for a variety of reasons. Asking Tina about the severity of her asthma will allow her to assess her condition.

Example Question:

How severe is your asthma?

Finding:

Reports asthma has been interfering with activities of daily life

(Available)

Pro Tip: Severe asthma can interfere with daily life. Asking Tina the degree to which asthma impacts her daily life can be illustrative of the relative severity of her asthma.

Example Question:

Is there anything you can’t do because of your asthma?

Finding:

Asked about character of symptoms

Finding:

Reports recent wheezing

(Found)

Pro Tip: Some people who experience chronic asthma may be accustomed to wheezing and, as a result, might not volunteer this information. Asking Tina if she’s been wheezing illustrates how her asthma is presenting.

Example Question:

Do you wheeze during an asthma exacerbation?

Finding:

Reports chest tightness

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe what happens when her asthma acts up will indicate how her individual symptoms manifest.

Example Question:

What happens when your asthma acts up?

Finding:

Denies chest pain

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina whether she experiences chest pain during an attack will indicate how her individual symptoms manifest.

Example Question:

Are the shortness of breath episodes associated with chest pain?

Finding:

Asked about cough

Finding:

Reports cough

(Found)

Pro Tip: A shallow history of a patient’s condition can provide a comparative baseline for juxtaposing an attack, exacerbation, and more regular breathing. Soliciting this information from Tina allows her to explain any recent developments with her asthma.

Example Question:

Have you been coughing?

Finding:

Cough has persisted since original asthma exacerbation 2 days ago

(Available)

Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not volunteer this information. Asking Tina how long she has been coughing illustrates how her asthma is presenting.

Example Question:

How long have you had a cough?

Finding:

Describes cough as “dry”

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.

Example Question:

How would you describe your cough?

Finding:

Describes cough as “small” and not severe

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe her cough specifies the way her individual symptoms manifest.

Example Question:

How severe is your cough?

Finding:

Reports cough slightly relieved by drinking water

(Available)

Pro Tip: Coughing can be a symptom of a constricted airway. Assessing what relieves Tina’s cough can open up a conversation about asthma management.

Example Question:

What makes your cough better?

Finding:

Has not treated cough with medication or home remedies

(Available)

Pro Tip: Some people who experience chronic asthma may be accustomed to coughing and thus might not treat this symptom. Asking Tina how she is treating her cough might reveal her current symptom management and health literacy.

Example Question:

Have you tried to treat your cough?

Finding:

Asked about aggravating factors

Finding:

Reports symptoms worse at night

(Found)

Pro Tip: Sometimes a condition will fluctuate during the course of the day. By asking Tina how her asthma differentially impacts her both during the day and at night, you are assessing an important change over time. NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Example Question:

Is your asthma worse at night?

Finding:

Reports symptoms increase when lying flat on back

(Available)

Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. By asking Tina if lying down causes shortness of breath, you’re assessing which positions might cause exacerbation.

Example Question:

Does lying down make your asthma worse?

Finding:

Reports symptoms aggravated by movement

(Available)

Pro Tip: Asthma can be aggravated by movements that constrict the respiratory airways. Inquiring into what activities make Tina short of breath can indicate possible triggers.

Example Question:

Is there anything you can’t do because of your asthma?

Medical History

Finding:

Confirmed use of medications

Finding:

Confirms medications (no new medications reported)

(Found)

Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.

Example Question:

What medications do you take?

Finding:

Followed up about inhaler use

Finding:

Uses an inhaler to treat asthma symptoms

(Found)

Pro Tip: It’s essential to ask specifically what medications a patient is using to treat her current complaint or any ongoing medical conditions.

Example Question:

Do you use an inhaler for your asthma?

Finding:

Inhaler is Proventil

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina what medication she takes for her asthma will indicate her treatment plan and the degree to which she complies with it.

Example Question:

What is the name of the inhaler you are currently using?

Finding:

Reports most recent inhaler use was this morning

(Found)

Pro Tip: Soliciting a shallow history of a patient’s medication history can reveal recent exacerbation. Asking Tina when she last used her inhaler will indicate when her symptoms most recently required medical treatment.

Example Question:

When did you last use your inhaler?

Finding:

Reports using inhaler every 4 hours or so since exacerbation

(Found)

Pro Tip: After an asthma exacerbation, patients often will become more reliant on medical tools like inhalers. Asking Tina how many times she’s used her inhaler in the past two days will point to the severity of her recent exacerbation.

Example Question:

How many times have you used your inhaler in the past two days?

Finding:

Prescribed usage is 2 puffs

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how many puffs of her inhaler she’s prescribed will indicate her treatment plan and the degree to which she complies with it.

Example Question:

How many puffs of your inhaler are you prescribed?

Finding:

Reports needing more than 2 puffs to resolve asthma symptoms

(Found)

Pro Tip: Inhaler effectiveness can vary over time for a variety of reasons. Asking Tina about the number on inhaler puffs she needs to resolve symptoms can indicate whether her asthma has worsened or point to potential problems like poor inhaler technique.

Example Question:

How many inhaler puffs do you need?

Finding:

Confirmed allergies

Finding:

Confirms allergies (no new allergies reported)

(Found)

Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.

Example Question:

Do you have any new allergies?

Finding:

Followed up on exposure to allergy and asthma triggers

Finding:

Reports cat allergy triggered recent episodes

(Found)

Pro Tip: Questions about what factors might have caused an illness can point to a patient’s environmental stressors, habits, and general wellbeing. Asking Tina what caused her asthma might indicate her health literacy and understanding of what factors impact her breathing. NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Example Question:

What started your recent asthma problems?

Finding:

Reports dust as a known trigger

(Found)

Pro Tip: Environmental factors can often be primary allergy triggers. Asking whether Tina has a dust allergy can reveal one such trigger.

Example Question:

Does being around dust trigger your asthma?

Finding:

Reports activity such as walking up stairs as a known trigger

(Found)

Pro Tip: Shortness of breath or asthma can be exercise-induced. Asking whether climbing stairs can be a trigger for Tina might reveal a possible provocation.

Example Question:

Does climbing stairs trigger your asthma?

Finding:

Denies seasonal pattern

(Available)

Pro Tip: Discerning what’s making Tina’s asthma worse can point to possible triggers like environmental factors, bodily positions, or movement that may have a bearing on Tina’s breathing. Asking Tina whether she has seasonal triggers will indicate, in part, Tina’s health literacy.

Example Question:

Do you have seasonal asthma triggers?

Finding:

Denies changes in weather as a trigger

(Available)

Pro Tip: For some patients, weather changes can be asthma irritants. Asking Tina if the weather impacts her asthma will indicate if weather is an irritant for Tina’s condition.

Example Question:

Do changes in weather make your asthma worse?

Finding:

Reports minimal exposure to asthma triggers at work

(Found)

Pro Tip: Environmental factors at home or work can often be primary allergy triggers. Asking Tina about possible allergens at work might indicate a relevant factor in her recent exacerbation.

Example Question:

Does anything at work make your asthma worse?

Finding:

Asked detailed questions about asthma history

Finding:

No current asthma doctor

(Found)

Pro Tip: Seeing a specialist, like an asthma doctor, can help patients to manage symptoms. Asking whether Tina is seeing an asthma doctor will allow you to assess her current treatment plan and healthcare access.

Example Question:

Do you have an asthma doctor?

Finding:

Diagnosed with asthma in childhood

(Found)

Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.

Example Question:

How long have you had asthma?

Finding:

Age of diagnosis was 2 1/2 years old

(Found)

Pro Tip: By determining the onset of asthma you can get a sense for Tina’s asthma history, instance, and frequency of exacerbation.

Example Question:

How old were you when you were diagnosed with asthma?

Finding:

Asked about hospitalizations for asthma

Finding:

Reports prior hospitalizations for asthma

(Found)

Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina if she’s been hospitalized, you are soliciting information about the history and severity of her condition.

Example Question:

Have you ever been hospitalized for asthma?

Finding:

Reports last hospitalization was age 16

(Found)

Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina when she was last hospitalized, you are soliciting information about the history and severity of her condition.

Example Question:

When was your last hospitalization for asthma?

Finding:

Estimates 5 total hospitalizations for asthma

(Available)

Pro Tip: Hospitalization for a condition, like asthma, can reveal its severity. By asking Tina the number of times she’s been hospitalized, you are soliciting information about the history and severity of her condition.

Example Question:

How many times have you been to the hospital?

Finding:

Reports she has never been intubated

(Found)

Pro Tip: Intubation for a condition, like asthma, can reveal its severity. By asking Tina if she’s been intubated, you are soliciting information about the history and severity of her condition.

Example Question:

Have you ever been put on a breathing tube?

Finding:

Followed up about non-medication forms of asthma management

Finding:

Denies record keeping of asthma exacerbation or shortness of breath episodes

(Available)

Pro Tip: For some patients, keeping records of asthma exacerbation allows them to monitor their conditions. Soliciting this information from Tina will show health literacy.

Example Question:

Do you use a chart to monitor your asthma?

Finding:

Denies using peak flow meter

(Available)

Pro Tip: A peak flow meter measures how well a patient’s lungs can expel air. By asking whether Tina uses a peak flow meter, you are asking about her health literacy and what kind of medical tools she uses to manage her asthma.

Example Question:

Do you check your peak flow regularly?

Finding:

Denies nebulizer use

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina if she uses a nebulizer for her asthma will indicate her treatment plan and the degree to which she complies with it.

Example Question:

Do you use a nebulizer?

Social Determinants of Health

Finding:

Asked about environmental control

Finding:

Reports living situation is tidy and free of dust

(Available)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

Have you noticed anything at home that aggravates your asthma?

Finding:

Reports hypoallergenic bedding hygiene

(Found)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

Do you change your bedding regularly?

Finding:

Reports avoiding animals and has no pets at home

(Available)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

Do you have pets at home?

Finding:

Reports avoiding exposure to secondhand smoke

(Found)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

Does anyone in your house smoke?

Social History

Finding:

Asked about exercise and activity level

Finding:

Reports general low activity level

(Found)

Pro Tip: Learning about a patient’s typical exercise habits helps

Example Question:

Do you exercise?

Finding:

Reports diminished activity due to asthma

(Available)

Pro Tip: Asking a patient if her current complaint affects her exercise level or (vice version) helps you understand if there is a causal relationship in symptoms.

Example Question:

Have you been able to exercise?

Finding:

Asked about possible contributing factors in health history

Finding:

Denies history of eczema

(Available)

Pro Tip: Children with eczema are often at a higher risk of developing asthma. In soliciting a medical history from Tina, you are getting a sense for the history of Tina’s asthma and related conditions.

Example Question:

Have you had eczema?

Finding:

Denies history of sinus problems

(Found)

Pro Tip: People with asthma are likely to also experience sinus problems. It is important to determine whether Tina has sinus problems as they can cause complicating symptoms in patients who also experience asthma.

Example Question:

Do you have a history of sinus problems?

Finding:

Denies history of GERD, heartburn, or indigestion

(Available)

Pro Tip: People with asthma are almost twice as likely to also experience GERD. It is important to determine whether Tina has GERD as GERD can cause shortness of breath in patients who also experience asthma.

Example Question:

Do you have gastroesophageal reflux disease?

Finding:

Denies history of COPD or emphysema

(Found)

Pro Tip: For a patient with a known history of COPD or emphesyma, the symptoms of cough or shortness of breath could be caused by that disease.

Example Question:

Have you ever been diagnosed with COPD?

Finding:

Asked about smoking, inhalants, or tobacco

Finding:

Denies history of tobacco use, including cigarettes

(Found)

Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked cigarettes can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.

Example Question:

Have you ever smoked cigarettes?

Finding:

Reports past history of marijuana use

(Found)

Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.

Example Question:

Have you ever smoked marijuana?

Finding:

Last use of marijuana was age 20 or 21

(Found)

Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina is she ever smoked marijuana can help you to discern whether smoking was an exacerbating factor for Tina’s asthma.

Example Question:

When was the last time you smoked marijuana?

Finding:

Denies inhaling substances

(Available)

Pro Tip: Smoking or inhaling substances can have adverse respiratory effects. Asking Tina when she quit smoking marijuana can help you to discern whether smoking recently exacerbated Tina’s asthma.

Example Question:

Have you ever experimented with inhaling substances?

Review of Systems

Finding:

Asked about general symptoms

Finding:

Denies recent respiratory or other illness

(Available)

Pro Tip: Broad, open questions will allow Tina to describe, in her own words, the specific pain and discomfort that she is experiencing.

Example Question:

Have you been sick recently?

Finding:

Denies fever

(Found)

Pro Tip: The presence or absence of fever can indicate if an infection is approaching sepsis, a life-threatening condition.

Example Question:

Have you had any fever symptoms?

Finding:

Denies nausea or vomiting

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like nausea, details the way her individual symptoms and pain manifest.

Example Question:

Have you had nausea or vomiting?

Finding:

Denies chills

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like getting chills, details the way her individual symptoms and pain manifest.

Example Question:

Have you had chills?

Finding:

Reports low energy level

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fatigue, details the way her individual symptoms and pain manifest.

Example Question:

Are you fatigued?

Finding:

Denies night sweats

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her injury, like night sweats, details the way her individual symptoms and pain manifest. NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Example Question:

Have you had night sweats?

Finding:

Asked review of systems for respiratory

Finding:

Denies phlegm or sputum

(Available)

Pro Tip: A productive asthma cough can expel sputum from the lungs. By asking whether Tina has been coughing up phlegm or sputum you are discovering the nature of Tina’s cough since exacerbation.

Example Question:

Have you been coughing anything up?

Finding:

Denies sore throat, swelling, or difficulty swallowing

(Available)

Pro Tip: Difficulty swallowing could indicate a more severe allergic reaction, or a physical problem with the throat.

Example Question:

Do you have any problems swallowing?

Finding:

Denies nasal drainage

(Found)

Pro Tip: Nasal drainage could suggest that the patient’s symptoms are caused by a viral or bacterial infection, or an allergy attack.

Example Question:

Do you have any nasal drainage?

Family History

Finding:

Asked about relevant family history

Finding:

Reports no recent illnesses with family members at home

(Available)

Pro Tip: For people with asthma, getting sick can increase their risk for exacerbation. If Tina’s had any family members recently sick, that might have caused her recent exacerbation.

Example Question:

Has anyone at home been sick?

Finding:

Reports younger sister as only family with asthma

(Found)

Pro Tip: Soliciting a family history helps you to determine which, if any, conditions are inherited. In asking Tina whether anyone in her family has asthma, you’re ascertaining whether Tina’s condition is inherited.

Example Question:

Does anyone in your family have asthma?

Finding:

Reports younger sister as only family member with allergies

(Available)

Pro Tip: A family history of allergies is an important factor to determine whether a patient is at risk for developing allergies.

Example Question:

Does anyone in your family have allergies?

Finding:

Reports no family history of eczema

(Available)

Pro Tip: People with a family history of eczema are often at a higher risk of developing asthma.

Example Question:

Does anyone in your family have eczema?

Finding:

Reports no family history of chronic nasal or sinus problems

(Available)

Pro Tip: People with a family history of sinus problems are often at a higher risk for asthma. If Tina has a family history of sinus problems, this could suggest inherited sensitivity.

Example Question:

Do you have a family history of sinus problems?

Finding:

Reports no family history of COPD or emphysema

(Available) NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

Pro Tip: Family history of COPD is a strong risk factor for COPD. It’s important to understand if the patient has an increased risk for all respiratory diseases.

Example Question:

Does anyone in your family have COPD?

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Lifespan Activity Time: 14 min

Tina’s second cousin was diagnosed with asthma at age 5. What would be included in your treatment plan? What factors might concern you related to compliance?

Student Response: Younger patients suffering from Asthma have the same treatment discourse just as adult patients. However, some medications dosage are based on the patient’s weight. Tina’s younger sister should use an inhaler with a spacer attached for proper administration of the medication. It is important that her caregiver assist her. Nebulizer treatment, as has been shown in numerous studies, tends to be less than effective. The provider should acknowledge that Tina’s sister may experience asthma attack while in school, hence the need to have a note that allows her to use it when needed. Educate the patient and her caregiver on the importance of having the inhaler close by, and most importantly, on how to use it effectively.

Model Note: Younger patients with asthma are treated with the same medication as adults. Some medication dosages are based on weight. She should use an inhaler with a spacer attached for proper medication administration and her caregiver should always assist her. Studies have shown that nebulizer treatments are a less efficient way to administer medication. The provider should acknowledge that she may have an asthma attack while in school, and therefore needs a note to allow her to use it as needed. The patient and her caregiver should be educated about the importance of having her inhaler close-by and how to use it.

Consider that Tina’s uncle is now 68 years old and has smoked heavily every day since he was fifteen. What would you expect to find in his respiratory assessment? How would this affect your oxygenation goals for this patient?

Student Response: An individual with such a long history of tobacco use is likely to have decreased breath sounds on auscultation. This is due to the likely emphysematous changes in his lungs associated with smoking. As alveoli become destroyed due to chronic inflammation and irritation, the surface area of the lungs decreases. This results in reduced area for gas exchange and subsequently, reduced blood oxygen saturation. As the patient’s body adjusts to this chronic oxygen deprivation, the caregiver must pay attention to the amount of supplemental oxygen given. When handling a patient with severe COPD, the goal is to keep oxygen saturation at 88% to 92%. If too much oxygen is given, the patient might experience a decreased drive to breathe, putting them at risk of death.

Model Note: He likely has decreased breath sounds on auscultation due to emphysematous changes to his lungs from smoking. As alveoli get destroyed from chronic inflammation and irritation, the surface area in the lungs is decreased. This leads to less area for gas exchange and subsequent decreased oxygen saturation. As his body adjusts to chronic oxygen deprivation, attention must be given to how much supplemental oxygen is given. The goal with someone with severe COPD is to keep oxygen saturation 88% to 92%. If he is given too much oxygen his drive to breathe with be decreased and puts him at risk for death.

 

 

Review QuestionsActivity Time: 19 min

If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion?

Correct: Dull percussion sounds are expected over the areas of diffuse infiltrate (accumulation of fluid and by products of inflammation) in a patient with pneumonia.

  • Hyperresonance
  • Tympany
  • Resonant
  • Dullness (Correct Response)

If the results of Tina’s pulse oximetry had been 97%, which of the following would have been true?

Correct: Pulse oximetry measures the percent of hemoglobin molecules that are filled with oxygen. Oxygen-saturated hemoglobin absorbs light wavelengths differently than unsaturated hemoglobin. The oximeter emits a light and reads the extent of wavelength absorption.

  • Partial pressure O2 = 97%
  • Unbound oxygen level = 97%
  • PaO2 = 97%
  • Arterial hemoglobin saturation = 97% (Correct Response)

Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding?

Correct: Increased breath sounds are indicative of lung consolidation (fluid-filled alveoli) or pleural effusion (fluid accumulation in the pleural space) because fluid transmits sounds better than air. This finding is usually accompanied by abnormal transmitted voice sounds and increased tactile fremitus.

  • Normal lung exam
  • Atelectasis
  • Fluid filled region of the lung (Correct Response)
  • Narrowed upper airways secondary to asthma

Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina’s history?

Student Response: Due to Tina’s history of Asthma, scattered wheezes are expected. Asthma is a chronic condition in which hyperactive airways become narrow due to the recurring inflammation and excess mucus production, which results in wheezing.

Model Note: Scattered wheezes are to be expected because of Tina’s history of asthma. Asthma is a chronic condition in which hyperreactive airways become narrowed by recurring inflammation and excess mucus production which results in wheezing.

When you observe a patient like Tina throughout an exam, there are many ways to determine whether a patient is experiencing respiratory distress. Identify one indicator of respiratory distress that can be assessed through observation alone.

Student Response: Among the observable signs associated with respiratory illness include accessory muscle use, audible respirations, wheezing or grunting, increased respiratory rate, bluish coloration around fingernails and lips, sweating, chest retractions, nasal flaring, tripod body positioning and inability to speak in complete sentences.

Model Note: Observable signs of respiratory distress include accessory muscle use, audible respirations, grunting or wheezing, increased respiratory rate, bluish coloration around the lips or fingernails, nasal flaring, chest retractions, sweating, tripod body positioning, and inability to speak in full sentences.

Describe how you would assess Tina for dyspnea.

Student Response: Being a subjective complaint, the only way to assess dyspnea is by asking the patient about her breathing. Example question to ask Tina include: “Do you ever experience shortness of breath or difficulty breathing?” If dyspnea is detected, be sure to ask about onset, environmental or physical factors that exacerbate the condition, duration, body positioning, sleep disturbances, and any possible relieving factors.

Model Note: Dyspnea is a subjective complaint that must be elicited by asking the patient about her breathing. Ask your patient, “Do you ever have shortness of breath or difficulty breathing?” If dyspnea is detected, be sure to ask about onset, environmental or physical factors related to exacerbations, duration, body positioning, sleep disturbances, and relieving factors. NR 509 Week 2 Shadow Health Respiratory Physical Assessment Assignment

 

Self-Reflection Activity Time: 18 min

Explicitly describe the tasks you undertook to complete this exam.

Student Response: To complete this exam, I interviewed Tina to understand her presenting problem. Once she reported having shortness of breath, I prodded further and discovered a history of asthma. I then asked specific questions on symptoms, exacerbating factors and relieving factors. This was then followed by a physical exam of Tina’s breathing, which included chest sounds and movements.

Explain the clinical reasoning behind your decisions and tasks.

Student Response: The decision to prescribe a maintenance inhaler is based on Tina’s recurring symptoms and the fact that her current albuterol inhaler was not offering any relief.

Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.

Student Response: I believe I could improve on time spent interviewing and assessing a patient presenting with asthma exacerbation. However, based on this assessment, I am now familiar with the physical symptoms to look out for in such a patient, and how to effectively manage them.

 

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